Sue looked forward to spending Christmas in Alexandria with her mom. Living in Arizona had its perks — and her career was going well — but she missed the sights, smells and traditions of Christmas in Old Town. But when Sue arrived home, she received an unexpected surprise.

Her mother, Mary, was 86, widowed and lived alone in the family home. The mother and daughter spoke by phone daily, but it had been a year since Sue saw Mary.

After a few days home, Sue started getting very concerned. Her mom seemed a little off. Mary woke up Sue two nights in a row, because as her mom said, she was “just looking for something.” Yet, in the morning, Mary was tired, confused and denied the previous night’s events.

Sue also noticed a few other little things. There was not much food in the house when she arrived, and her mom had not changed clothes during the entire visit.

In addition, there were little piles of the oddest things around the house Mary always kept pristine. Worse yet, Mary wasn’t taking her blood pressure medication.

Then one morning really concerned Sue. She was awake before her mother, and when Mary woke up, she was very confused. Mary asked Sue what she was doing home and wondered about the whereabouts of Bob, her deceased husband. He died 10 years ago.

Sue replied: “Mom, do you mean dad? You know, he’s been dead since 2001, and I’m here to spend Christmas with you.”

Mary seemed a little startled by the response but laughed it off, saying she wasn’t fully awake yet.

“How are things with your mom?” the neighbor asked. “It’s really good you’re here. You know, we’re worried about her …”

How do you know when a loved one needs more help or is no longer safe in his or her home? Some of the key signs are: increased confusion; poor medication and medical care follow-up; poor nutrition and self-grooming; changes in sleep patterns; and confusion with finances. There are several supports available, such as home companions, adult day care and meals on wheels.

Most senior residents of Alexandria want to live in their homes. However, when a person is no longer safe without 24-hour supervision, it’s time to explore other types of support, like a live-in family caregiver, an assisted living facility — and if there are severe health problems — possibly a nursing facility.

When a family member or friend feels concerned about the safety of a senior, a call to the DCHS Office on Aging is the best way to receive information, resources and an assessment. And it makes for a happier holiday for everyone.

The writer is a therapist supervisor for older adult clinical services for the City of Alexandria.